When Mouth Pain Isn’t Just a Tooth Problem
Salivary gland stones are tiny mineral deposits that form in the ducts, the small tubes that carry saliva from the glands to the mouth. While they may be no bigger than a grain of sand, or sometimes a few millimeters, these stones can cause significant pain, noticeable swelling, and even infection when they create a blockage and prevent saliva from flowing freely.
The good news is that this condition, known as sialolithiasis, is highly treatable. The purpose of this guide is to help you understand what causes these frustrating blockages, how our ENT specialists accurately diagnose them, and what advanced, effective treatments, including minimally invasive options, can bring you lasting relief.
Understanding the Role of Salivary Glands
You have three main pairs of these glands, each named for its location.
- Parotid Glands: The largest pair, located in front of your ears and extending toward your cheekbones.
- Submandibular Glands: Located under your jaw (the mandible).
- Sublingual Glands: Located beneath the floor of your mouth and under your tongue.
Saliva is far more than just “spit.” It is an essential fluid that keeps your mouth moist, begins the process of digestion, and contains antibodies that help prevent infections and tooth decay. The glands produce saliva, which then travels through small ducts into your mouth.
When a sialolith forms and lodges itself in one of these ducts, the flow of saliva essentially stops. This backup leads to increased pressure within the gland, resulting in the characteristic swelling and pain, especially when the gland is trying to produce a lot of saliva, like at mealtimes.
What Are Salivary Gland Stones?
Sialolithiasis is the clinical term for the condition where these calcified, stone-like deposits form inside the salivary ducts. These stones are composed primarily of calcium phosphate and calcium carbonate, the same minerals found in teeth and bones.
Interestingly, the submandibular gland is affected most often, about 80% of the time. This is because its main duct, the Wharton’s duct, is long and actually runs upward from the gland to the floor of the mouth. This structure makes gravity work against the flow, causing saliva to be thicker and more likely to stagnate, which promotes mineral deposition.
Stones can range dramatically in size, from tiny micro-deposits to stones several millimeters across, and you may have a single stone or multiple. While salivary gland stones are not considered dangerous or cancerous, an untreated, persistent blockage can cause chronic discomfort, recurring infections, and irreversible damage to the gland over time.
Also Read: Important Things To Know About Salivary Gland Masses
Why Salivary Gland Stones Form
The exact cause of sialolithiasis is often multifactorial, meaning it results from a combination of risk factors rather than a single trigger. The underlying issue, however, is anything that causes saliva to become too thick or stagnate.
Contributing factors include:
- Dehydration: This is a major factor. Not drinking enough water concentrates the saliva, making it a more fertile environment for mineral buildup and stone formation.
- Reduced Saliva Flow: Certain medications, including antihistamines, diuretics, and some antidepressants, can decrease salivary production, leading to stagnation.
- Altered Saliva Composition: High calcium levels in the saliva or other chemical imbalances can promote the calcification process.
- Inflammation or Infection: A previous bout of infection (sialadenitis) or trauma can cause scarring or narrowing within the duct, trapping minerals.
Symptoms: When to Suspect a Salivary Gland Stone
The most classic and telltale symptom is pain or swelling that is directly related to eating. When you see, smell, or taste food, your glands immediately ramp up saliva production. If there’s a blockage, the pressure spikes.
You should suspect a salivary gland stone if you experience:
- Pain or swelling in the cheek, under the jaw, or beneath the tongue, especially before or during meals.
- A “tight” or full sensation in the mouth or neck that often subsides slowly after you finish eating.
- A feeling of decreased saliva or a dry mouth, despite being hydrated.
- Tenderness or a palpable lump around the affected gland.
- If infection develops (a condition called sialadenitis), you might experience fever, a visible reddening of the skin, or a bad taste in the mouth due to pus discharge.
How ENTs Diagnose Salivary Gland Stones
Diagnosing a salivary gland stone often requires the expertise of an Ear, Nose, and Throat (ENT) specialist (otolaryngologist). We use a combination of physical and advanced imaging techniques.
Physical Examination
An experienced ENT specialist will start by carefully examining and palpating (gently pressing) the floor of your mouth and along the jawline. Often, we can feel the stone directly. The key clinical clue that points toward a blockage is swelling that significantly worsens around mealtimes.
Imaging Studies
If a stone is suspected but not felt, or if a deeper stone is present, imaging is essential:
- Ultrasound: This is a noninvasive, first-line test. It uses sound waves to create an image and can successfully detect most stones, especially those near the gland’s surface.
- CT Scan: A CT scan provides a more detailed, three-dimensional view of the duct system and can pinpoint smaller or deeper stones that an ultrasound may miss.
- Sialography or MRI Sialography: This involves injecting a small amount of radio-opaque dye into the duct to create an outline of the duct system. This helps identify blockages, strictures (narrowing), or inflammation not visible on other scans.
Salivary Endoscopy (Sialendoscopy)
The gold standard for both diagnosis and treatment is sialendoscopy. This is a minimally invasive technique that revolutionized the management of salivary gland stones. The ENT uses an incredibly small, thin scope with a light and a camera to look directly into the salivary ducts. This procedure allows the specialist to locate the exact size and position of the stone and, in many cases, remove it in the same visit.
Treatment Options for Salivary Gland Stones
Conservative (Non-Surgical) Treatments
For very small stones or partial obstructions, initial management focuses on encouraging the stone to pass naturally:
- Hydration: Drinking plenty of water is important to thin the saliva and increase flow.
- Gland Massage: Gentle massage of the affected area can help “milk” the stone out of the duct.
- Sialogogues: These are substances that intensely stimulate saliva production, which can sometimes flush the stone out. Think of eating sour candies, chewing gum, or sucking on lemon slices.
- Medication: Warm compresses and non-steroidal anti-inflammatory medications (NSAIDs) can help with pain and swelling.
Minimally Invasive Procedures
For stones that refuse to pass, minimally invasive techniques are now the preferred route:
- Sialendoscopy: As mentioned, this is the main treatment. The ENT uses micro-instruments like small wires, baskets, or tiny forceps threaded through the scope to extract the stone without any external incision. It’s usually performed on an outpatient basis under local or light general anesthesia, offering a quick recovery.
- Stone Fragmentation: For larger, more stubborn stones, the ENT can use a laser or a tiny drill (lithotripter) delivered through the scope to break the stone into smaller, easily removable pieces before extraction.
Surgical Options (When Necessary)
Surgery is a last resort, reserved for cases where endoscopic removal is impossible:
- Duct Incision: For stones that are too large or deeply embedded to be retrieved endoscopically, a small incision may be made in the mouth or neck to access and remove the stone directly.
- Gland Removal: In the rare event of severe, repeated obstruction, chronic infection, or irreversible damage to the gland, partial or complete removal of the submandibular gland (sialadenectomy) may be required. Modern ENT techniques are focused on preserving gland function whenever possible.
Preventing Future Salivary Gland Stones
If you’ve had one stone, you have a chance of recurrence. Prevention centers on maintaining healthy, steady saliva flow:
- Stay Hydrated: This is the single most important preventative measure. Drink water consistently throughout the day to keep your saliva thin.
- Manage Diet: Limit excessive caffeine and alcohol, as both can be dehydrating.
- Stimulate Flow: Chew sugar-free gum or use sugar-free sialogogues (sour drops) occasionally, especially if you feel dry.
- Medication Review: Discuss any side effects with your primary care doctor if you are taking medications that cause frequent or severe dry mouth.
- Follow-Up: Regular ENT checkups are advisable if you’ve had stones in the past to monitor the health of your glands.
When to See an ENT Specialist
Don’t dismiss persistent pain or swelling as “just a toothache.” If you experience any of the following, an early evaluation by an ENT specialist is important:
- Persistent swelling or pain in the mouth, jaw, or under the tongue.
- Recurrent pain or swelling that flares up when you eat or drink.
- Signs of infection, such as fever or pus discharge.
- Swelling that does not improve within a day or two with home care (like hydration and massage).
Also Read: How You Know It’s Time to See an Ear Nose and Throat Specialist
Conclusion: Small Stones, Big Relief with Expert ENT Care
Salivary gland stones are a common, but often overlooked, cause of oral and facial pain that can significantly disrupt your quality of life. The good news is that with modern diagnostic tools like ultrasound and, especially, sialendoscopy, treatment is now fast, highly effective, and minimally invasive.
Ready to find relief from persistent jaw or mouth pain? Contact us in either West Hills or Encino today to schedule a comprehensive evaluation with one of our specialized ENT physicians.